<form id="edit-form" class="form-horizontal col-sm-12" role="form" data-toggle="validator" method="POST" action="">

		<div class="form-group" >
			<label class="control-label col-xs-2 col-sm-2">车牌号:</label>
			<div class="col-xs-6 col-sm-6">
				<input type="text" name="row[car_number]" placeholder="请输入车牌号" class="form-control" />
			</div>
		</div>
		<div class="form-group" >
			<label class="control-label col-xs-2 col-sm-2">发生时间:</label>
			<div class="col-xs-6 col-sm-6">
				<input name="row[consume_date]" placeholder="请选择发生时间" type="text" class="form-control datetimepicker"  data-rule="required"  data-date-format="YYYY-MM-DD">
			</div>
		</div>
		<div class="form-group" >
			<label class="control-label col-xs-2 col-sm-2">起始公里数:</label>
			<div class="col-xs-6 col-sm-6">
				<input type="text" name="row[start_mileage]" placeholder="请输入起始公里数" class="form-control miles-calcute" data-rule="required"/>
			</div>
		</div>
		<div class="form-group" >
			<label class="control-label col-xs-2 col-sm-2">结束公里数:</label>
			<div class="col-xs-6 col-sm-6">
				<input type="text" name="row[end_mileage]" placeholder="请输入结束公里数" class="form-control miles-calcute" data-rule="required"/>
			</div>
		</div>
		<div class="form-group" >
			<label class="control-label col-xs-2 col-sm-2">公里数:</label>
			<div class="col-xs-6 col-sm-6">
				<input type="text" name="row[mileage]" placeholder="请输入公里数" class="form-control" data-rule="required"/>
			</div>
		</div>
		<div class="form-group" >

			<label class="control-label col-xs-2 col-sm-2">金额:</label>
			<div class="col-xs-6 col-sm-6">
				<input type="number" name="row[consume_money]" placeholder="请输入金额" class="form-control" data-rule="required"/>
			</div>
		</div>
		<div class="form-group">
			<label for="c-image" class="control-label col-xs-2 col-sm-2">消费凭证:</label>
			<div class="col-xs-6 col-sm-6">
				<div class="input-group">
					<input id="c-image" class="form-control" placeholder="请上传消费凭证" size="35" name="row[file_ids]" type="text" >
					<div class="input-group-addon no-border no-padding">
						<span><button type="button" id="faupload-image" class="btn btn-danger faupload" data-url="ajax/upload?type=7" data-input-id="c-image" data-mimetype="image/gif,image/jpeg,image/png,image/jpg,image/bmp" data-multiple="false" data-preview-id="p-image"><i class="fa fa-upload"></i> {:__('Upload')}</button></span>
					</div>
					<span class="msg-box n-right"></span>
				</div>
				<ul class="row list-inline faupload-preview" id="p-image"></ul>
			</div>
		</div>
		<div class="form-group">
			<label class="control-label col-xs-2 col-sm-2">备注:</label>
			<div class="col-xs-6 col-sm-6">
				<textarea name="row[remark]"  class="form-control" rows="3" placeholder="请填写备注"></textarea>
			</div>
		</div>

	<div class="form-group layer-footer">
		<label class="control-label col-xs-2 col-sm-2"></label>
		<div class="col-xs-4 col-sm-8">
			<button type="button" class="btn btn-success btn-embossed ">{:__('OK')}</button>
			<button type="reset" class="btn btn-default btn-embossed">{:__('Reset')}</button>
		</div>
	</div>
</form>